© Springer International Publishing AG 2018Trisha Peel (ed.)Prosthetic Joint Infectionsdoi.org/10.1007/978-3-319-65250-4_1
1. Introduction to Prosthetic Joint Infection
Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, Victoria, Australia
KeywordsProsthetic joint infectionBiofilmEpidemiologyDiagnosisManagementPrevention
Total joint replacement surgery represents one of the highest volume medical interventions globally, contributing an estimated 0.65% to the world gross domestic product (GDP) . The clinical and economic benefits of this surgery are undermined by the impact of prosthetic joint infection. These infections, while uncommon (1–3%), are associated with substantial patient morbidity, including the need for prolonged hospitalisation, repeat surgery, and antibiotic exposure .
Prosthetic joint infections are challenging to diagnose and treat, due to the unique behaviour of microorganisms when in contact with prosthetic material. In the presence of prosthetic material, such as a prosthetic joint replacement , the microorganisms undergo a change, transforming from the “free-living” or “planktonic” form that clinicians familiarly encounter in sepsis to the “stationary” or “sessile” form. In its sessile form, the microorganism develops complex architectural arrangements comprised of microorganisms within an extracellular “slime” or matrix: together, these microorganisms and the matrix constitute the “biofilm ” [3, 4]. The microorganisms in the biofilm have a slower rate of turnover compared to the planktonic counterparts. The biofilm protects the microorganism against the host’s immune responses and also impedes the activity of antimicrobial agents, therefore promoting the persistence of these infections [2–4]. The majority of modern-day laboratory techniques are optimised for the detection of planktonic microorganisms; therefore, detection of microorganisms in the biofilm is difficult . As knowledge of biofilms increases, evidence for the optimal strategies to diagnose, treat, and prevent these infections is evolving, with a recent explosion in research and interest in these infections. This book provides a comprehensive review of the up-to-date evidence.